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Healthcare Leader speaks to Nick Broughton – who took over Southern Health Trust in November 2017 – about his role and the challenges of turning around a failing organisation
When Dr Nick Broughton took on the role of chief executive of Southern Health NHS Foundation Trust in November 2017, it was an organisation under considerable scrutiny.
The reasons for that are well-documented. In 2013, 18-year-old Connor Sparrowhawk drowned in a bath while in the care of a Southern Health facility. The investigations that sfollowed uncovered serious issues within the organisation, with one report revealing that the trust had failed to properly investigate the deaths of hundreds of patients.
In March 2018, the trust was fined £2m over the preventable deaths of Sparrowhawk and 45-year-old Teresa Colvin, – who died at Woodhaven Adult Mental Health Hospital in Calmore, Hampshire in 2012. The trust was found to have failed to protect Ms from serious self-harm.
Broughton, who was previously chief executive of the Somerset Partnership NHS Foundation Trust, says he arrived to find an organisation lacking in confidence, with ‘very low morale’ and some major challenges in terms of the quality of care being provided.
‘To me, the key challenge was one of cultural change,’ Broughton says. ‘We needed to ensure that quality improvement and delivering high quality care was the absolute priority and create a culture that really engaged and empowered its workforce.”
‘The board and the ward’
Southern Health employs more than 6,000 staff and one of Broughton’s first priorities has been to close the gap between ‘the board and the ward’, improving communication among his colleagues and creating an environment where staff feel valued and listened to.
‘The trust has been so embroiled in assurance and under so much [understandable] scrutiny that I think staff have not felt as listened to as they would have liked by management,’ he explains.
‘I was keen to redefine that relationship with the board and convey a sense of optimism and positivity – there’s no reason why the organisation can’t go on to be outstanding.’
Broughton has done this in several ways. He began by setting up ‘listening events’, making himself visible to staff and providing an opportunity for them to tell him directly what they see as the challenges. He also started a fortnightly blog as a means to communicate with the whole organisation, which has seen an uptake of around 700 readers so far.
‘We’ve also set up a video podcast following board meetings where my director of communications videos me on his iPhone and I summarise what’s been discussed,’ he says. ‘That’s helped to make the board more accessible and understandable to staff.’
Quality improvement methodology
To drive up care standards, the trust – which after its last inspection, published by the CQC on 3 October, is still rated as ‘requires improvement’ overall – is using an approach known as ‘quality improvement methodology.
The principles of this methodology were originally designed by the car manufacturer Toyota, and brought into the health sector by the Virginia Mason hospital in Seattle.
‘Virginia Mason is seen as a world leader in terms of quality improvement in the health sector and they are working with a number of challenged NHS providers,’ Broughton says.
The Virginia Mason approach was adopted in Northumberland roughly a decade ago, and with the support of NHS Improvement, Southern Health formed a partnership with the Northumberland, Tyne and Wear NHS Foundation Trust – which is rated ‘outstanding’ by the CQC – to assist in training its staff to use the methodology.
So far, 32 people have completed training in quality improvement methodology, with a further 16 starting the training at the end of October. The first group of trainees facilitated a series of workshops for staff, service users, families and carers, from which 150 improvement plans were developed. These are now being implemented across the trust.
‘It’s a really exciting initiative,’ Broughton says. ‘It’s not unique – but it’s something that we had identified we needed to do and that has been a real priority area for us.’
‘Involving patients and families’
Another priority for Broughton has been to improve how the organisation communicates and engages with patients and their families in the development and delivery of services.
The trust was severely criticised for its treatment of Sparrowhawk and Colvin’s relatives, with the judge who delivered the £2m fine commenting that it was a ‘regrettable fact’ that both families had had to campaign to uncover problems within the organisation, adding that Connor’s mother, Dr Sara Ryan, had endured ‘entirely unjustified criticism’ during her campaign.
Broughton says much of the work in this area had started before he took up the post of chief executive, but from the outset both he and the board, which is essentially new, ‘have been very clear that we need to be an organisation which has its patients at the very heart of what we do’.
‘Our patients are closely involved in the transformation programme and one of our service users was in the first cohort of people to be trained in the quality improvement methodology.
‘We are absolutely committed to our service users being involved in all this work going forward, as equal partners, and I think that sends a very powerful message across the trust.’
A patient engagement lead has been appointed to support this work, and the organisation is also rolling out an initiative called the ‘triangle of care’. This involves clinicians working in collaboration with patients and carers in a three-cornered partnership.
Information packs, a communication plan and a support group for carers with relatives on inpatient wards have been set up so far, with ‘carer leads’ due to be identified for all services by the end of 2018.
‘This [triangle of care] is something that’s up and running in other organisations but that we’ve yet to fully embrace here in Hampshire, so it’s a big focus for us,’ Broughton adds.
‘Winning back confidence’
Broughton, who has a background as a forensic psychiatrist, clearly has his work cut out for him. However, he says he was attracted to the post in part because he was aware that despite having been through ‘some very difficult times’, Southern is an organisation with ‘great potential’.
The trust is one of the largest providers of community health and specialist mental health and learning disability services in the UK – with staff working from more than 200 sites in Hampshire – including community hospitals, health centres, and inpatient units.
‘I was also attracted to Southern because of the breadth of its mental health services – the opportunity to lead a large provider of those services was appealing,’ Broughton says.
One of his greatest challenges as chief executive, Broughton adds, is managing the level of scrutiny the organisation is subject to.
Southern Health is seen as a failing organisation and, as a result, a great deal of time goes into providing the regulators with assurance. Broughton says that while this is understandable, it ‘can be a little frustrating because you want to get on with the transformational work’.
He is nevertheless optimistic about Southern Health’s future and although he says he can’t hand on heart say they’ve ‘cracked it yet,’ there are ‘green shoots of recovery’.
‘I see this as a long-term project – it’s not something that can be sorted in six to 12 months. But I am more than hopeful – I’m very confident – that it can be sorted.’